Dedicated dermoscopy units assess individuals at high risk for melanoma. Understanding the reasons for referral to these units and the epidemiological profile of referred patients can help optimize health care resources and determine who benefits most from dermoscopic evaluation. We analyzed reasons for referral and epidemiological characteristics of 413 patients with at least 1 high-risk factor for melanoma seen at a dedicated dermoscopy unit over a period of 10 years. We also analyzed the number of necessary excisions (NNE) for each melanoma diagnosed, histologic features, and associations between nonenvironmental factors and diagnosis. The main reasons for referral were a past history of melanoma (21.5%), changes detected by the patient or a relative (20%), clinical and/or dermoscopic findings suggestive of malignancy (19.4%), and a family history of melanoma (17.4%). Seventy-six of the 178 excised lesions were melanomas (NNE per melanoma detected, 2.34). Older age was the only risk factor significantly associated with the development of melanoma.